Monitoring the status of HIV/AIDS in China

The surveillance system for the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in China began in 1986. Substantial improvements in the surveillance system not withstanding, China still confronts many challenges in monitoring the epidemic in 2006.;In the first component of my thesis, I reviewed the evolution of the HIV/AIDS surveillance system and its data sources. Improved surveillance programs have enabled more accurate estimates. HIV infection rates continue to increase and 80% of estimated HIV infections through 2005 were related to injection drug use or commercial sex work.;In the second component, I assessed the validity of a novel serologic method---a HIV-1 subtypes B, E, and D, IgG capture enzyme immunoassay (BED-CEIA) to identify recent HIV-1 seroconversion. In our BED-CEIA validations, all 29 specimens with known dates of recent seroconversions were positive by BED-CEIA. Estimated HIV-1 incidence and observed incidence from a prospective cohort study were very similar. BED-CEIA is an immunological tool that shows promise for HIV seroincidence surveillance from affordable, cross-sectional surveys, but needs further validation.;In the third component, I synthesized the estimates of HIV/AIDS prevalence for Dehong Prefecture, Yunnan Province, China using a variety of different data sources and modeling procedures. My models estimated the population prevalence for HIV in Dehong Prefecture to be 1.3% (likely range: 0.9% to 1.7%), such that 13 500 (likely range: 8 200 to 18 300) people were estimated to be living with HIV/AIDS in Dehong Prefecture in 2005.;In summary, my thesis work demonstrated the BED-CEIA assay as a promising way to distinguish between recent and long-term HIV infection from cross-sectional survey specimens. My models confirmed that current HIV prevention, care, and treatment challenges are substantial in Dehong Prefecture in southwestern China. Use of all components of the HIV/AIDS surveillance system, synthesizing multiple data sources, provides a more accurate picture of the dynamics of HIV/AIDS, such that it should be feasible to replicate this work, synthesizing multiple data sources using several procedures for other areas of China.